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Craniopharyngiomas: our experience in Lyon

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Abstract

Objective

We reviewed our experience in surgical treatment of craniopharyngiomas. Surgical treatment of craniopharyngiomas in children represents a challenge for neurosurgeons because it presents a different set of surgical problems. Results are controversial and debates concerning strategies to ameliorate the rate of success and to decrease the rate of morbidity and mortality are ongoing. Post-surgical quality of life is related to the anatomical relationship between the hypothalamic region, vascular structures and optic pathways.

Discussion

From 1985 to 2004, 60 children (age range, 4 months to 18 years) were treated in our institution. Since 1987, all patients were studied with pre- and postoperative MRI. Two groups of patients were distinguished: a group of 36 patients treated with surgical direct surgery; a second group of 24 patients treated only with intracystic chemotherapy with bleomycin (18 patients) or associated with surgery (six patients). In the first group, the removal of lesion was total in 74% of cases. Two patients died in the early postoperative period and two more died later (early mortality of 5% and late mortality of 11%). All patients presented ante-pituitary insufficiency and diabetes insipidus, which required substitutive treatment. Twenty-two patients presented with visual problems, including amaurosis in two cases. In the group treated with bleomycin, 18 patients presented a primary cystic or a mixed form of craniopharyngioma and six patients showed a cystic recurrence. Eighteen patients were treated with bleomycin only. The dose used varied from 30 mg to a maximal dose of 150 mg, with a middle dose of 60 mg in the large majority of cases. In this group, the cyst disappeared in 12 patients and reduced to 30% of its initial volume, and stabilization of the lesion was achieved in the other six patients. Only 11 patients presented partial endocrine insufficiency. Of the 18 patients, 16 were of school age, 14 of whom were following a normal educational program and two an assisted program. No mortality was reported.

Conclusion

Our experience showed that in the group treated with intracystic chemotherapy alone, results were better with a low rate of morbidity and mortality. Endocrinological, visual and neuropsychological evaluations were also correlated with better outcome. In cases of cystic craniopharyngiomas, we considered bleomycin as the treatment of choice. For solid forms or for cases resistant to intracystic chemotherapy with bleomycin, direct surgery has to be proposed.

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References

  1. Al-Mefty O, Massounam M, Weaver P, Sakatin S, Jinkins JR, Fox JL (1985) Microsurgery of giant craniopharyngiomas in children. Neurosurgery 17:685–695

    Google Scholar 

  2. Al-Mefty O, Kersh J, Smith R (1990) The long term side effects of radiation therapy for benign brain tumors in adults. J Neurosurg 73:502–512

    CAS  PubMed  Google Scholar 

  3. Amacher AL (1980) Craniopharyngioma: the controversy regarding radiotherapy. Child Brain 6:57–64

    CAS  Google Scholar 

  4. Blacklund E, Axelson B, Bergstrand C, Erikson A, Noren B, Ribesso E, Rahn T, Schnel P, Tallstedt L, Saaf M (1989) Treatment of craniopharyngiomas. The stereotactic approach in a ten to twenty-three year’s perspective. Surgical, radiological and ophthalmological aspects. Acta Neurochir 99:11–19

    CAS  Google Scholar 

  5. Broggi G, Giorgi C, Franzini A, Servello D, Solero CL (1989) Preliminary results of intracavitary treatment of craniopharyngioma with bleomycin. J Neurosurg Sci 33:145–148

    CAS  PubMed  Google Scholar 

  6. Carmel P, Antunes S, Chang C (1982) Craniopharyngiomas in children. Neurosurgery 11:382–388

    CAS  PubMed  Google Scholar 

  7. Cavazzuti V, Fischer EG, Welch K (1983) Neurological and psychological sequelae following different treatment of craniopharyngioma in children. J Neurosurg 59:409

    Google Scholar 

  8. Chakrabarti I, Amar PA, Couldwell W, Weiss MH (2005) Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngiomas. J Neurosurg 105:650–657

    Google Scholar 

  9. Carpentieri SC, Waber D, Scott MR, Goumernorova LC, Kieran MW, Cohen LE, Kim F, Billet AL, Tarbell NJ, Pomeroy SL (2001) Memory deficits among children with craniopharyngiomas. Neurosurgery 49(5):1053–1058

    Google Scholar 

  10. Choux M, Lena G, Genitori L (1991) Le craniopharyngiome de l’enfant. Neurochirurgia 37(Suppl 1):1–174

    Google Scholar 

  11. Clopper R, Meyer WJ, Udvarhelyi GB, Honey J, Aarabi B, Hulvihil JJ, Piasio M (1977) Post-surgical IQ and behavioral data on twenty patients with a history of childhood craniopharyngioma. Psychoneuroendocrinology 2:365–372

    Article  CAS  PubMed  Google Scholar 

  12. Duff JM, Meyer BF, Ilstrup D, Laws ED, Schlek CD, Scheithauer BW (2000) Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46(2):291–305

    Article  PubMed  Google Scholar 

  13. Contine LS, Randall SH, Rubin P, MacDonald J (1989) Craniopharyngiomas: fluctuation in cyst size following surgery and radiation therapy. Neurosurgery 24:53–59

    PubMed  Google Scholar 

  14. Epstein FJ, Handler MH (1994) Craniopharyngioma: the answer. Proc. Symposium, New York, NY, Dec. 17–19, 1993. Pediatr Neurosurg 21(Suppl 1):1–132

    Google Scholar 

  15. Fischer EG, Welch K, Belli JA, Wallman J, Shillito JJ, Winston KR, Cassady R (1985) Treatment of craniopharyngiomas in children 1972–1981. Neurosurgery 62:496–501

    CAS  Google Scholar 

  16. Garcia-Uria J (1978) Surgical experience with craniopharyngioma in adults. Surg Neurol 9:11–14

    CAS  PubMed  Google Scholar 

  17. Graham PH, Gattamanrni HR, Birch JM (1992) Pediatric craniopharyngiomas: a regional review. Br J Neurosurg 6:187–193

    CAS  PubMed  Google Scholar 

  18. Hader WJ, Steinbock P, Hukin J, Fryer C (2000) Intratumoral therapy with bleomycin for cystic craniopharyngiomas in children. Pediatr Neurosurg 33:211–218

    Article  CAS  PubMed  Google Scholar 

  19. Hasegawa T, Kondziolka D, Hadjipanayis CG, Lundsford DL (2004) Management of cystic craniopharyngiomas with phosporus-32 intracavitary irradiation. Neurosurgery 54(4):813–822

    Google Scholar 

  20. Hoff JF, Patterson RH Jr (1972) Craniopharyngiomas in children and adults. J Neurosurg 36:299–302

    CAS  PubMed  Google Scholar 

  21. Hoffman HJ, Hendrick EB, Humphreys RP, Buncic JR, Amstrong DL, Jenkin RD (1977) Management of craniopharyngioma in children. J Neurosurg 47:218–227

    Google Scholar 

  22. Kahn GA, Gosh HH, Seeger JF, Hicks SP (1973) Forty-five years experience with craniopharyngioma. Surg Neurol 1:5–12

    CAS  PubMed  Google Scholar 

  23. Konovalov AN (1998) Technique and strategies of direct surgical management of craniopharyngiomas. In: Apuzzo MLJ (ed) Surgery of the third ventricle, 2 edn. Williams and Wilkins, Baltimore, pp 1133–1142

    Google Scholar 

  24. Lapras C, Patet JD, Mottolese C, Gharbi S, Lapras Jr C (1987) Craniopharyngiomas in childhood: analysis of 42 cases. Prog Exp Tumor Res 30:350–358

    CAS  PubMed  Google Scholar 

  25. Maira G, Anile C, Rossi GF, Colosimo C (1995) Surgical treatment of craniopharyngiomas: an evaluation of the transphenoidal and pterional approaches. Neurosurgery 36:715–724

    Google Scholar 

  26. Maira G, Anile C, Colosimo C, Cabezas D (2000) Craniopharyngiomas of the thirs ventricle: trans-lamina terminalis approach. Neurosurgery 47(4):857–865

    Google Scholar 

  27. Matson DD, Crigler JF (1969) Management of craniopharyngioma in childhood. J Neurosurg 30:377–390

    CAS  PubMed  Google Scholar 

  28. Mac Lone DB, Raimondi AJ, Naidich TP (1982) Craniopharyngiomas. Child Brain 9:188–200

    Google Scholar 

  29. Mottolese C, Stan H, Hermier M, Berlier P, Convert J, Frappaz D, Lapras C (2001) Intracystic chemotharapy with bleomycin in the treatment of craniopharyngiomas. Childs Nerv Syst 17:724–730

    Article  PubMed  Google Scholar 

  30. Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H, Brada M (1993) Craniopharyngioma—long term results following limited surgery and radiotherapy. Radiother Oncol 26:1–10

    CAS  PubMed  Google Scholar 

  31. Regine WF, Mohiuddin M, Kramer S (1993) Long term results of pediatric and adult craniopharyngiomas treated with combined surgery and radiation. Report of 92 cases. Radiother Oncol 27:13–21

    CAS  PubMed  Google Scholar 

  32. Rougerie J (1979) What can be expected from the surgical treatment of craniopharyngiomas in children. Report of 92 cases. Child Brain 5:433–449

    CAS  Google Scholar 

  33. Samii M, Samii A (1995) Surgical management of craniopharyngiomas. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques: indications, methods and results, 3rd edn., vol 1. Saunders, Philadelphia, pp 357–370

    Google Scholar 

  34. Shillito J (1980) Craniopharyngiomas: the subfrontal approach, or none at all? Clin Neurosurg 27:188–205

    PubMed  Google Scholar 

  35. Shillito J (1986) Treatment of craniopharyngioma. Clin Neurosurg 33:533–546

    PubMed  Google Scholar 

  36. Steno J (1985) Microsurgical topography of craniopharyngiomas. Acta Neurochir 35(Suppl):94–100

    CAS  Google Scholar 

  37. Sung DI, Chang CH, Harisiadis L, Carmel PW (1981) Treatment results of craniopharyngiomas. Cancer 47:847–852

    Google Scholar 

  38. Sweet WH (1976) Radical surgical treatment of craniopharyngioma. Recurrent craniopharyngiomas: therapeutic alternatives. Clin Neurosurg 23(52–79)206–229

    CAS  PubMed  Google Scholar 

  39. Symon L, Sprich W (1985) Radical excision of craniopharyngiomas. Results in 20 patients. J Neurosurg 62:174–181

    CAS  PubMed  Google Scholar 

  40. Takahashi H, Nakazawa S, Shimura T (1966) Evaluation of postoperative intratumoral injection of bleomycin for craniopharyngioma in children. J Neurosurg 84:124–126

    Google Scholar 

  41. Till K (1982) Craniopharyngioma. Child Brain 9:179–187

    CAS  Google Scholar 

  42. Tomita T, Mac Lone DB (1993) Radical resections of childhood craniopharyngiomas. Pediatr Neurosurg 19:6–14

    Google Scholar 

  43. Weiner M, Wisoff J, Rosenberg M, Kupersmith M, Cohen H, Zagzag D, Shiminski-Mahler T, Flam E, Epstein F, Miller D (1994) Craniopharyngiomas: a clinical analysis of factors predictives of recurrence and functional outcome. Neurosurgery 35:1001–1011

    CAS  PubMed  Google Scholar 

  44. Yasargil MG, Curcic M, Kis M, Siegenthaller G, Teddy PJ, Roth P (1990) Total removal of craniopharyngiomas approaches and long-term results in 144 patients. J Neurosurg 73:3–11

    Google Scholar 

  45. Van Effenterre R, Boch A (1997) Craniopharyngiomes de l’adulte et de l’enfant. Etude d’une série chirurgicale de 106 cas consécutifs. Neurochirurgia 43:187–211

    Google Scholar 

  46. Zanon N (1999) Bleomycin treatment of cystic craniopharyngioma. In: Choux M, Di Rocco C, Hockley A, Walker M (eds) Pediatric neurosurgery. Churchill Livingstone, Edinburgh

    Google Scholar 

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Authors and Affiliations

  1. Pediatric Neurosurgical Service, Hôpital Neurologique et Neurochirurgical “Pierre Wertheimer”, 59 Boulevard Pinel, Lyon Cedex 3, France

    C. Mottolese, A. Szathmari & P. Berlier

  2. Radiological Service, Hôpital Neurologique et Neurochirurgical “Pierre Wertheimer”, 59 Boulevard Pinel, Lyon Cedex 3, France

    M. Hermier

Authors
  1. C. Mottolese
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  2. A. Szathmari
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  3. P. Berlier
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  4. M. Hermier
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Correspondence to C. Mottolese.

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Mottolese, C., Szathmari, A., Berlier, P. et al. Craniopharyngiomas: our experience in Lyon. Childs Nerv Syst 21, 790–798 (2005). https://doi.org/10.1007/s00381-005-1242-1

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